About 900 000 South Africans live with bipolar disorder. Jeff, a highly successful engineer, is one of them. This is his story.

Jeff (43) holds a top position at an engineering firm and manages multi-million rand projects. He is an attractive and successful man. Jeff is also one of the 450 000 to 900 000 (1 – 2 % of the total population) of South Africans with bipolar mood disorder (BMD). Treatment has made it possible for him to lead a normal, fulfilling life. In fact, if he did not mention BMD, nobody would have guessed.

During his life, Jeff has always worked hard and played hard. But his life changed forever when he had his first manic episode in 1994 at the age of 33. He had just emigrated to New Zealand and his wife was out of the country at the time. As sometimes happens during manic episodes, Jeff became psychotic and developed several grandiose schemes. These included the possible opening of branches of South African companies all over New Zealand. He also simultaneously became paranoid, believing that people were out to get him. Convinced that he had an endless supply of money, he spent thousands and ran up huge debts.

Having never been ill before, he had no way of understanding what was happening to him. A manic episode also causes one to lose insight and it is very difficult for people in the middle of this to accept that they need help. A neighbour eventually managed to get him committed to a psychiatric hospital where he stayed for six weeks. Although he recovered, word soon spread about his illness. He lost his job and his permanent residency permit was withdrawn.

Back in Cape Town, Jeff hit the other pole of BMD, a deep depression. He became verbally abusive towards his wife and withdrew sexually, prompting his wife to divorce him.

Second time round
Filled with anger and bitterness, he struggled to cope. But Jeff still managed to work and support himself. This changed again in 1997 when he had a major psychotic episode. Paranoia struck once again. His former lavish lifestyle reappeared, and again he was living in hotels and stashing money in security boxes all over the country. He managed to spend R150 000 during this six-week period of his illness.

He recalls bizarre experiences in which he felt he had to become the protector of sex workers. He travelled through the country and at one point was dumped next to the road in the middle of nowhere with nothing more than a pair of short pants on. He attempted to tackle cars and trucks head-on in a frustrated attempt to escape from his “psychosis” once and for all. Eventually after he ran through the fields approximately 10 km to Colesberg, he was found by the police, who took him to hospital in Bloemfontein. Because he wasn’t committed, he discharged himself the following day and caught a flight back to Cape Town.

But much of what happened during this time still remains a blank.

“This happens during a manic episode,” explains Jeff. “Bipolar is also called a heart attack of the brain, but I would rather call it a stroke. You lose chunks of time. You end up in one place and have no idea how you got there and what had happened in the past days, even weeks. It is extremely distressing and scary.”

What probably also have contributed to the memory loss, is the excessive amounts of the sedative Ativan he took during this time. Although being treated by a psychiatrist since his return to South Africa, his illness was never properly managed. According to Jeff, he seldom saw his psychiatrist. Instead, he was given repeat scripts which allowed him to stock up on huge amounts of antidepressants and sedatives – most of which he took during his manic episode. According to research, antidepressants should never be used during a manic episode. However, since Jeff lacked insight into his illness and was not being monitored at the time, he continued taking them, in excessive quantities.

Eventually Jeff came down from his manic high with the help of an experienced psychiatrist who managed to treat him with antipsychotic medication. He then once again slumped into a deep depression. He was unemployed for 14 months and spent his days watching videos or simply sleeping.

“I couldn’t do anything. I had no energy, I couldn’t even read because the words kept jumping all over the page. I had no joy in my life.”

One day he listened to a radio talk show on BMD which changed his life for the better. Until that time, all Jeff knew about this disorder was what he had read in a pamphlet given to him by a psychologist. For the first time he learnt more about the condition and could listen to people who had been through similar experiences. He decided that something needed to be done to help others in a similar position and, together with two psychologists, Jeff started the Western Cape Bipolar Support Group.

With the help of a his new psychiatrist and the right medication, Jeff’s condition improved dramatically. He was also fortunate to find a psychologist who treated him for several years and helped him learn to accept and deal with the illness and the impact it had on his life. He was employed at his current firm in 1998 and has since never even used up his annual sick leave. He is highly successful, in a stable relationship and is functioning normally in all aspects of his life.

Through the support group, he managed to see and help people in different stages of the illness. The knowledge helped him to gain insight into his condition. He learnt what triggers an episode (in his case primarily stress and lack of sleep), how to identify early warning signs and how to take care of himself.

“It is a balance you need to learn. I manage my stress carefully and take time out when I need to. I sometimes need time on my own. My girlfriend initially felt insecure when I wanted to be on my own for a day or two, but she now knows that it is one of the ways in which I take care of myself.”

Living with the illness
“Treatment and the support group helped me to get my self-respect back. People who haven’t been through this kind of experience, cannot imagine how this damages your sense of self, your self-confidence and your self-respect.”

“When you become ill, you don’t know who you are. You experience a side of yourself that you never knew existed. After a manic episode, you beat yourself up because of all the foolish things you’ve done, because of the unwise decisions you made and because of the way in which you have treated people. This only makes you feel more depressed. You need to remind yourself that those actions were because of your illness, however, it is important to remember you also cannot use your illness as an excuse not to take responsibility and to continue behaving badly when you are well.”

Living with BMD has taught Jeff to pay more attention to people and to be more sensitive to their needs and feelings. He has learnt to become more tolerant. “If you have BMD, you hope that people will be tolerant towards you. You can’t expect tolerance if you are not tolerant towards others.”

But the downside is that you are always monitoring and analysing yourself. “I constantly replay conversations and interactions and wonder: was I perhaps a bit too up or a bit too down? I often worry whether something is a sign that I’m getting ill again. The constant analysis is extremely tiring.”

Jeff’s illness also resulted in several losses – not only jobs but also friendships. Of the 100 people who attended Jeff’s wedding in 1993, only four have remained friends. Many of his family members also rejected him during his last episode. Today he has a close group of friends who all know about his illness.

Talking about it
“You make a judgement call of who you tell and who you don’t tell about your illness. If someone is mature and broadminded, I tell them. Some people reject me, but I’ve learnt to let it go and walk away.

“People are still so ignorant about the disorder and the stigma is huge. They are far more inclined to learn about physical illnesses such as diabetes than they are about mental illness.”

The need to stay healthy
Jeff still sees medication as the key component to staying well. He has been on the same medication and dosage for the past seven years and has never skipped a dose.

But managing his illness is costly. Until last year, his medical scheme covered his medication costs. Now, as a result of the Council for Medical Schemes' recent decision to delete BMD from the list of 25 chronic conditions that have to be covered, he has to foot the bill. Jeff is fortunate in that he is able to afford his medication. He is also fortunate that a relatively cheap combination of drugs (approximately R750 per month) works for him. But he is concerned about the majority of people with BMD who will no longer be able to pay for treatment, especially those who need more expensive drug combinations which could cost over R2 000 per month.

Staying healthy and preventing another episode are crucial. With every episode, ones resistance to stress is lowered and you become more prone to relapse. After a few episodes, some people have little to no resistance to stress and are almost permanently in the grip of the bipolar cycle.

“I don’t think I will survive another psychotic episode. It will either kill me or it will leave me a pauper for the rest of my life. My friends are very supportive but I have no idea if they would stick with me if I have another psychotic episode. I’ll be on my own, that’s why I have to stay well.” - (Ilse Pauw, Health24)

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